Adverse events in hospitalized patients are catastrophic and costly to individuals, hospitals and society. Despite a decade of widespread attention and action, little progress has been made in improving patient safety and reducing preventable adverse events. The use of electronic health records (EHR) is one promising system-level initiative that may improve provider performance, interdisciplinary communication, reduce adverse patient events, improve the overall quality of patient care, and ultimately improve patient satisfaction with hospital care. This proposed cross-sectional study will empirically examine levels of EHR functionality and utilization and it's association with the delivery of nursing care, taking into account a large number of patient characteristics as well as hospital characteristics including measures of nurse staffing and organizational climate. The sample includes 2006 nurse survey data from more than 7,000 registered nurses working in 72 acute care hospitals in New Jersey, and patient discharge data from approximately one million patients hospitalized during the same time. Study data will be compiled from five sources including: 1) the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) available from the Agency for Healthcare Research and Quality (AHRQ), 2) data on hospital characteristics from New Jersey Department of Health and Senior Services (NJDHSS), 3) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute database of EHR implementation, 4) Centers for Medicare and Medicaid Services (CMS) data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), and 5) New Jersey nurse survey data. Outcomes of interest include nursing-sensitive AHRQ patient safety indicators (PSIs), length of stay, hospital readmission, and patient satisfaction. The analytic approach will use multiple logistic and ordinary least squares regression models to estimate the effects of EHR implementation on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. Robust procedures with Huber-White sandwich variance estimators and mixed models will be used to account for the clustering of patients within hospitals. This study addresses AHRQ's goal to improve patient safety and health care quality in several ways. First, findings from this study wil inform a technologically based, multi- faceted approach to reducing inpatient adverse events and enhancing patient satisfaction. Second, findings disseminated through a comprehensive plan will inform key healthcare executives and policymakers to render better decisions regarding valuable healthcare resources. This study will provide the evidence necessary to improve the safety and quality of patient care in New Jersey and nationwide. PUBLIC HEALTH RELEVANCE: Each year thousands of hospitalized patients experience an adverse event that is a direct result of healthcare. This study will determine if the implementation of the electronic health record is associated with the quality of nursing care delivery and the outcomes of hospitalized patients. This will impact public health by generating knowledge that may be used to direct valuable resources that will have the greatest positive effect for hospitalized patients.